{"id":1823,"date":"2014-05-23T07:05:24","date_gmt":"2014-05-23T12:05:24","guid":{"rendered":"http:\/\/www.medradclinics.com\/?p=1823"},"modified":"2016-04-01T15:13:33","modified_gmt":"2016-04-01T20:13:33","slug":"hemodialysis-access-case-5-ken-u-ekechukwu-md-mph-facp","status":"publish","type":"post","link":"https:\/\/www.medradclinics.com\/?p=1823","title":{"rendered":"Hemodialysis Access, Case 5. <i> Ken U. Ekechukwu, MD, MPH, FACP.<\/i>"},"content":{"rendered":"\n\t\t<style type=\"text\/css\">\n\t\t\t#gallery-1 {\n\t\t\t\tmargin: auto;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-item {\n\t\t\t\tfloat: left;\n\t\t\t\tmargin-top: 10px;\n\t\t\t\ttext-align: center;\n\t\t\t\twidth: 33%;\n\t\t\t}\n\t\t\t#gallery-1 img {\n\t\t\t\tborder: 2px solid #cfcfcf;\n\t\t\t}\n\t\t\t#gallery-1 .gallery-caption {\n\t\t\t\tmargin-left: 0;\n\t\t\t}\n\t\t\t\/* see gallery_shortcode() in wp-includes\/media.php *\/\n\t\t<\/style>\n\t\t<div id='gallery-1' class='gallery galleryid-1823 gallery-columns-3 gallery-size-thumbnail'><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1825'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Composite-line-diagram-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-1825\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Composite-line-diagram-150x150.jpg 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Composite-line-diagram-109x109.jpg 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Composite-line-diagram-100x100.jpg 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-1825'>\n\t\t\t\tLine diagram: Composite drawing of findings of angiogram of left arm loop graft\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon portrait'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1826'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Loop-graft-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-1826\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Loop-graft-150x150.jpg 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Loop-graft-109x109.jpg 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Loop-graft-100x100.jpg 100w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Loop-graft.jpg 512w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-1826'>\n\t\t\t\tLeft forearm loop graft angiogram: Large aneurysm of the distal left brachial artery (black arrow); the loop graft (blue arrow); the left brachial vein (red arrow).\n\t\t\t\t<\/dd><\/dl><dl class='gallery-item'>\n\t\t\t<dt class='gallery-icon landscape'>\n\t\t\t\t<a href='https:\/\/www.medradclinics.com\/?attachment_id=1824'><img loading=\"lazy\" decoding=\"async\" width=\"150\" height=\"150\" src=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Color-doppler-US-showing-aneurysm-compressing-new-graft-150x150.jpg\" class=\"attachment-thumbnail size-thumbnail\" alt=\"\" aria-describedby=\"gallery-1-1824\" srcset=\"https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Color-doppler-US-showing-aneurysm-compressing-new-graft-150x150.jpg 150w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Color-doppler-US-showing-aneurysm-compressing-new-graft-109x109.jpg 109w, https:\/\/www.medradclinics.com\/wp-content\/uploads\/2014\/07\/Color-doppler-US-showing-aneurysm-compressing-new-graft-100x100.jpg 100w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/a>\n\t\t\t<\/dt>\n\t\t\t\t<dd class='wp-caption-text gallery-caption' id='gallery-1-1824'>\n\t\t\t\tColor doppler ultrasound of the aneurysm of the distal left brachial artery. \n\t\t\t\t<\/dd><\/dl><br style=\"clear: both\" \/>\n\t\t<\/div>\n\n<p><span style=\"font-size: 22px;\"><strong>Clinical problem:<\/strong> 44-year-old man who had had multiple failed arteriovenous accesses in the past. His new left forearm non-autogenous brachiobrachial access did not work well at his most recent hemodialysis session.<\/span><\/p>\n<p><span style=\"font-size: 22px;\"><strong>Findings at imaging:<\/strong>\u00a0The angiogram shows a loop arteriovenous graft connecting the distal left brachial artery to the proximal left brachial vein. The artery, the graft, and the vein are patent, the vein yet to mature. A large aneurysm overlays the distal left brachial artery, obscuring the arterial anastomosis of the graft and the effect of the aneurysm, if any, on the juxta-anastomotic graft. Axial color\u00a0<\/span><span style=\"font-size: 22px; line-height: 37.7142868041992px;\">Doppler<\/span><span style=\"font-size: 22px;\">\u00a0view of the aneurysm confirms a massive, swirling structure with a turbulent interior. The\u00a0arrow at its 11:00 position identifies the juxta-anastomotic segment of the graft, partially collapsed by the aneurysm.<\/span><\/p>\n<p><span style=\"font-size: 22px;\"><strong>Intervention:<\/strong> The patient was referred to vascular surgery for aneurysmectomy, which corrected the problems at dialysis. The mass proved to be a pseudoaneurysm of the distal brachial artery thought to be iatrogenic.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Clinical problem: 44-year-old man who had had multiple failed arteriovenous accesses in the past. His new left forearm non-autogenous brachiobrachial access did not work well at his most recent hemodialysis session. Findings at imaging:\u00a0The angiogram shows a loop arteriovenous graft connecting the distal left brachial artery to the proximal left brachial vein. The artery, the [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[35,89],"tags":[],"class_list":["post-1823","post","type-post","status-publish","format-standard","hentry","category-case-gallery","category-hemodialysis-access-management","pmpro-has-access"],"_links":{"self":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1823","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1823"}],"version-history":[{"count":14,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1823\/revisions"}],"predecessor-version":[{"id":2554,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1823\/revisions\/2554"}],"wp:attachment":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1823"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1823"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1823"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}